Day-to-day cover

Benefits guide - English
Benefits guide - Afrikaans

Guardian plan

  • General day-to-day limit

    Paid at the Transmed rate

    Includes:

    • GP and specialist consultations
    • Acute and over-the-counter (OTC) medication
    • Routine pathology and radiology

    All other day-to-day benefits not specifically mentioned above
    M0 R4 270
    M+ R7 500

    100%

    at the Transmed rate

  • General practioner (GP) consultations

    Paid at the Transmed rate

    Subject to the availability of funds in the general day-to-day limit

    100%

    at the Transmed rate

  • Specialist consultations

    Paid at the Transmed rate

    Subject to the availability of funds in the general day-to-day limit

    100%

    at the Transmed rate

  • Acute and over-the-counter (OTC) medication

    Paid at the Transmed rate

    Subject to the availability of funds in the general day-to-day limit

    Acute and OTC formularies apply

    Fund exclusions apply

    100%

    at the Transmed rate

  • Out-of-hospital pathology

    Paid at the Transmed rate

    Subject to the availability of funds in the general day-to-day limit

    100%

    at the Transmed rate

  • Out-of-hospital radiology

    Paid at the Transmed rate

    Basic radiology (X-rays)
    Subject to the availability of funds in the general day-to-day limit

    100%

    at the Transmed rate

  • Optical benefits

    Benefit provided through PPN protocols

    NETWORK BENEFIT
    Optical benefits are subject to authorisation by PPN and clinical protocols/prescribed rules apply

    Beneficiaries can claim every 24 months

    Examination
    Limited to 1 consultation to the value of R730, including refraction, glaucoma screening, visual field screening and artificial intelligence screening for the detection of diabetic retinopathy

    Frames/Spectacles/Lenses
    R950 towards frame and/or lens enhancements together with 1 pair of clear, single- vision lenses to the value of R210 or clear, bifocal lenses to the value of R445 or clear, multifocal lenses to the value of R770

    OR

    Contact lenses
    Limited to R1 380

    NON-NETWORK BENEFIT
    Members will be liable for a co-payment for out-of-network services

    Examination
    Limited to 1 consultation to the value of R350

    Frames/Spectacles/Lenses
    R760 towards frame and/or lens enhancements, together with 1 pair of clear, single-vision lenses to the value of R210 or clear, bifocal lenses to the value of R445 or clear, multifocal lenses to the value of R770

    OR

    Contact lenses
    Limited to R1 380

    Please call PPN on 0861 103 529

    100%

    at the Transmed rate

  • Basic dentistry

    Provided through DENIS
    Subject to protocols and limitations
    No annual limit but only stated codes are covered

    Paid at the Transmed rate

    Root canal
    Limited to 1 per family per year

    Please call DENIS on 0860 104 941

    100%

    at the Transmed rate

  • Specialised dentistry

    Benefit provided through DENIS
    Subject to protocols and limitations
    Limited to R4 110 per family per year

    Paid at the Transmed rate

    Crowns
    Limited to 1 per family every 2 years for beneficiaries 16 years and older

    Dentures
    Limited to 1 set per jaw every 4 years for beneficiaries older than 21
    Limited to 1 set chrome cobalt-frame dentures every 5 years for beneficiaries 21 years and older

    Pre-authorisation required
    Please call DENIS on 0860 104 941

    100%

    at the Transmed rate

  • Orthodontics

    No Benefit

  • Dentures

    R1 040 stand-alone benefit per family for beneficiaries older than 21

    Accounts in excess of this limit is payable from the specialised dentistry limit of R4 110 per family per year

    Paid at the Transmed rate

    Pre-authorisation required
    Please call DENIS on 0860 104 941

    100%

    at the Transmed rate